| NPI | 1518463462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302921) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 23480) |
| Enumeration Date | 2018-03-31 |
| Last Update Date | 2018-12-05 |